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To the Editor: In their study of the metabolic syndrome and mortality, Dr Lakka and colleagues¹ did not assess sleep-disordered breathing (sleep apnea). Obesity, the central feature of the metabolic syndrome, is also the greatest risk factor for obstructive sleep apnea (OSA), which associated with cardiovascular disease in a dose-dependent way.^2-4 The severity of sleep-disordered breathing also correlates with many other risk factors for cardiovascular disease, including markers of oxidative stress and of inflammation, such as adhesion molecules, interleukin 6, and C-reactive protein.^5-6 More convincing, however, is the evidence that treatment of OSA, in the absence of weight loss or other treatment for metabolic syndrome, reduces blood pressure⁷ and cardiovascular risk.⁴

Barbara Phillips, MD, MSPH
Department of Internal Medicine
University of Kentucky College of Medicine
Lexington

1. Lakka H-M, Laaksonen DE, Lakka TA, et al. The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men. JAMA. 2002;288:2709-2716. FREE FULL TEXT 2. Shahar E, Whitney CW, Redline S, et al. Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study. Am J Respir Crit Care Med. 2001;163:19-25. FREE FULL TEXT 3. Mooe T, Franklin KA, Holmstrom K, Rabben T, Wiklund U. Sleep-disordered breathing and coronary artery disease: long-term prognosis. Am J Respir Crit Care Med. 2001;164:1910-1914. FREE FULL TEXT 4. Peker Y, Hedner J, Norum J, Kraiczi H, Carlson J. Increased incidence of cardiovascular disease in middle-aged men with obstructive sleep apnea: a 7-year follow-up. Am J Respir Crit Care Med. 2002;166:159-165. FREE FULL TEXT 5. Dyugovskaya L, Lavie P, Lavie L. Increased adhesion molecules expression and production of reactive oxygen species in leukocytes of sleep apnea patients. Am J Respir Crit Care Med. 2002;165:934-939. FREE FULL TEXT 6. Shamsuzzaman ASM, Winnicki M, Lanfranchi P, et al. Elevated C-reactive protein in patients with obstructive sleep apnea. Circulation. 2002;105:2462-2464. FREE FULL TEXT 7. Pepperell JC, Ramdassingh-Dow S, Crosthwaite N, et al. Ambulatory blood pressure after therapeutic and subtherapeutic nasal continuous positive airway pressure for obstructive sleep apnoea: a randomised parallel trial. Lancet. 2002;359:204-210. FULL TEXT | ISI | PUBMED

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;289:1241.

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